Firstpost podcast: Govt must address misconceptions over burial, cremation of COVID-19 victims, says public health expert Dr Aiswarya Rao
To be a doctor working on the coronavirus frontlines, only to have your dignity stripped in death with no proper burial is the saddest thing to come out of the COVID-19 pandemic, says Dry Aishwarya Rao in Episode 9 of he podcast
To be a doctor working on the COVID-19 frontlines, only to have your dignity stripped in death with no proper burial is the saddest thing to come out of this pandemic.
In episode nine, Dr Aiswarya takes on burials and cremations in times of coronavirus. With the violence surrounding the burial of doctors in Chennai, it's high time the conversation shifts from handwashing and social distancing to the stigma related to burial/cremation of COVID-19 victims.
Edited script of Episode 9:
I am Dr Aiswarya Rao, and I am a paediatrician and public health consultant. Today on my show, Dr Aiswarya Explains, we are looking at a couple of really heart-wrenching incidents that occurred in Chennai, surrounding the death of two doctors that shook the public and the medical community over the past one week.
Today as we enter Day 28 of the national lockdown which is a preventive measure for the containment of the coronavirus pandemic in India, we have exceeded 17,000 positive cases and 560 deaths. We are nowhere near the peak, let alone flattening of the transmission curve. More healthcare workers and frontline workers are susceptible to the infection and like in other countries, we are going to have our fair share too, in spite of our best efforts.
We are looking at a long period of transmission ahead of us, along with a host of measures for its containment. It’s a daily evolving and dynamic process and the Centre as well as state governments are doing as best as they can with the resources available and the existing health infrastructure. The key component here is the cooperation of the public at every step of the strategy utilised for outbreak control.
On Sunday, Dr Simon Hercules, a neurosurgeon, died of COVID-19 infection in Chennai. A mob attacked the hearse carrying his body and stopped the burial. A week earlier, an orthopaedic surgeon from Nellore who was treated at a Chennai city hospital also succumbed to the virus. Local residents had protested the cremation of his body in a city crematorium fearing the virus may spread.
Both incidents turned ugly very quickly, especially, the one that took place on Sunday night.
The local residents resorted to violence, attacked the drivers of the ambulance which was carrying the dead body of the neurosurgeon. The body had to be abandoned in the middle of the road while the people accompanying it fled for their life.
Later, a colleague of the deceased doctor came and drove the ambulance to another site of burial with police protection. He describes digging the pit himself with one shovel, with the help of another policeman, because the JCB that was prepared for the digging of the pit was abandoned by the its operator fearing public fury.
Much of Monday, news and on social media was filled with outrage by the medical fraternity and the general public at large for the lack of dignity accorded to the dead doctors in their death. And rightly so. The fury is understandable because the doctors acquired their infection during the discharge of their duties and in a sense sacrificed their life while trying to heal their patients. Similarly, several cases have been reported, of healthcare workers and police personnel on COVID-19 duty being attacked by angry mobs in Madhya Pradesh, Uttar Pradesh, Bihar and Bengaluru.
I was immediately reminded of a similar incident from the frontline of the war against the HIV virus in which I was involved for nearly 15 years. In the early days of the epidemic, I have experienced hostility from neighbourhoods whenever there was an AIDS-related death. Often, we had to intervene in the middle of the night whenever there was a death to avert mob violence.
I remember one of my patients, a young woman with HIV who committed suicide. This was in 2002. The post-mortem took a long time and the body was handed over late to us. By then, the neighbourhood of the TP Chatram burial ground created a ruckus. This is the very same burial ground which was the scene of the violence when Dr Hercules’ body was first taken on Sunday.
Thankfully, in 2002, it started raining heavily (it was the month of November) and the crowd dispersed much to our relief. So we buried the girl in the pouring rain in the dark of the night with my car headlights providing the light. We didn't want to put the other lights on in the ground fearing it would attract a mob. The memory of the incident is deeply ingrained in me.
I also distinctly remember another incident (one of several) where an elderly Catholic nun running a community care centre in a village in Theni district of Tamil Nadu had to bury a man who died of AIDS. She dug the pit herself with a shovel and spade, because the villagers refused to assist.
Of course, much of the stigma and discrimination surrounding HIV has decreased today, and such incidents declined as treatment became more accessible and people with HIV began to live normal and productive lives.
Coming back to the current situation in which the doctors were denied dignity in their death, in a tough note, the centre urged the states to take tough action against the mob attacking healthcare workers. The Chennai Police responded to the incident at the burial ground by arresting 20 persons who were allegedly part of the mob that attacked the ambulance. But is that enough?
The 10 page FAQ — the frequently asked questions — by the MOHFW on their now much-visited website covers a variety of myths and misconceptions with facts and explanations, but there is nothing on death of a person with COVID infection and the subsequent risk of infection spread at the time of burial or cremation, or following that.
There are six posters displayed on the website but none are addressing this issue. Also scanning the numerous public service messages that are circulating all over the television, radio, print and social media, there is nothing in India that addresses this specific fear.
The manual on Outbreak Communication published by the World Health Organisation in 2005 outlines the best practices for effective communication with the public during an outbreak with the least possible disruption to economies and society. This is evidence-based, field-tested communication guidance and it has strategies that promote the public health goal of rapid outbreak control. The role of public communication during the pandemic cannot be understated. The five tenets of the communication are to build trust, announce early, be transparent, respect public concerns, and plan in advance. This communication strategy was put together largely drawing from the experiences culled from all the previous pandemics such as HIV, SARS, MERS, Anthrax and Bovine spongiform encephalopathy outbreaks to name a few. These were real lessons that were learnt from the field and applied scientifically.
We must acknowledge that the public have concerns that are diverse and legitimate, especially in this day of 24x7 news coverage where everyone is bombarded with dreaded news about the pandemic and the havoc it is causing not only socially but also economically. Public health officials need to understand the fear of the public regardless of how unscientific or unfounded they may seem.
The information developing arm of the Health Department both at the Centre and the state governments need to engage in a dialogue in which those responsible for issuing information respect public concerns as legitimate, seek to understand their foundation, and then give out messages accordingly that are simple, clear and full of facts. This risk communication is a two-way conversation.
We cannot deny that there has been a failure of the government on providing timely messages to the public to allay their anxiety and concerns. The first cremation was obstructed one week back and the same was repeated on Sunday with even more violence. There is a recurring pattern here. Clearly, the messages continue to be about wash hands and social distancing only, even 2.5 months after the first case was reported in India, while there is a huge gap in the information provided to prevent tragedies like what happened on Sunday at a burial ground in Chennai.
The interim guidelines issued by the WHO in late March (the Government of India too issued directive on 15 March) this year, on Infection prevention and control for the safe management of a dead body in the context of COVID 19 is quite simple and clear.
Dead bodies do not transmit disease. A dead person cannot sneeze or cough or breathe. So, the common ways of spreading the infection end the moment a person dies. Viral replication also stops. The skin may contain viral particles, and therefore, the body has to be neatly wrapped in a cloth, and no need for a body bag. Only the healthcare workers preparing the dead body and the mortuary staff need to wear PPE. So long as there is no touch, there is zero percent chance of spread of infection. Both burning or burying a dead body are absolutely safe. The virus cannot climb up from the 8 feet deep pit. Neither can it survive the 4,000 degrees centigrade fire in the crematorium. Fumes don't carry the virus.
These simple messages, if communicated properly to the public, could have averted indignities to both the doctors, who laid their lives while caring for their patients. The need of the hour is timely and simple information to the public, and not police action and punishment. That never works.
I am Dr Aiswarya Rao, and this is me signing off, until I can meet you again with my next podcast. Thanks for listening.
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